Patient says she needs blood stored in glass not plastic

[Mabel Adams]

We have a pre-op patient with a history of transfusion reactions to autologous blood twice in 2010.  The S/S listed include chills, nausea, drop in BP, fever, urticaria, pruritis, cyanosis of fingertips, some shortness of breath.  She says that after a workup with an allergist that they think that she reacts to blood stored in plastic and needs any blood she gets to have been stored in glass instead.  Does anyone know anything about transfusion reactions to plasticizers in blood bags or the like?  We are pretty sure we could save her life with pre-medicating for any needed transfusion and avoiding transfusion sounds like a great plan but I'm interested if anyone has any information on the topic.  Also, is it possible to collect blood for transfusion in an FDA-approved glass bottle in the US?

[Malcolm Needs ☆]

In a rush, as I am lecturing in 8 minutes, but, if you can get hold of Klein HG and Anstee DJ, Mollison's Blood Transfusion in Clinical medicine. 11th edition, 2005, Blackwell Publishing, look at page 683, Sensitivity to latex and page 691, Toxic substances in plastic.

Sorry to be so brief.

[Baby Banker]

I vaguely remember hearing that patients may react to the chemical used to sterilize plastics.  I think it's a bigger problem with patients on dialysis.

[exlimey]

1 hour ago, Baby Banker said:

I vaguely remember hearing that patients may react to the chemical used to sterilize plastics.  I think it's a bigger problem with patients on dialysis.

That was the formaldehyde solution that was used to sterilize reusable dialysis machines in situ. The patients would often make an anti-N-like antibody ("N") that could cause trouble in the AbScr and XM. In the old days, dialysis patients used a LOT of blood. Now, with EPO, they hardly use any.

Technically, they didn't have an allergy to the plastics/materials, but rather, as you pointed out, the sterilizing agent. However, it would not surprise me if some patients do develop allergies to today's materials. It seems that everyone is allergic to everything, these days.

[Malcolm Needs ☆]

There were plastic bags made in which the plasticiser leeched from the bag into the blood, but I have an idea that these are no longer used.  As you may be able to tell by now, this is NOT my specialist subject!

[Marilyn Plett]

I'm curious about the "diagnosis". Was the allergist thinking out loud about possibilities? Or has he done some diagnostic testing and issued a report? Could a hyper-reactive immune system respond to some of the effects of storage on RBCs or WBCs? (I'm really going out on a limb here since by knowledge is limited). I've collected donor blood in glass bottles 40+ years ago and more recently for my brother-in-law the veterinarian who needed to transfuse a dog. I don't know if they're still available.

 

[Baby Banker]

21 hours ago, exlimey said:

That was the formaldehyde solution that was used to sterilize reusable dialysis machines in situ. The patients would often make an anti-N-like antibody ("N") that could cause trouble in the AbScr and XM. In the old days, dialysis patients used a LOT of blood. Now, with EPO, they hardly use any.

Technically, they didn't have an allergy to the plastics/materials, but rather, as you pointed out, the sterilizing agent. However, it would not surprise me if some patients do develop allergies to today's materials. It seems that everyone is allergic to everything, these days.

I remember that too, but this was a gas I think.  It left a residue in the disposables that caused some patients to go into anaphylactic shock.  It was in the Technical Manual a few versions back.  

[exlimey]

10 minutes ago, Baby Banker said:

I remember that too, but this was a gas I think.  It left a residue in the disposables that caused some patients to go into anaphylactic shock.  It was in the Technical Manual a few versions back.  

Eek ! I don't like the sound of that.

Ethylene oxide (ETO) is a gas used to sterilize materials that can't tolerate other processes (heat/radiation).

[tricore]

• Format: Abstract

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J Allergy Clin Immunol. 1978 Jul;62(1):30-2.

Allergy to a product(s) of ethylene oxide gas: demonstration of IgE and IgG antibodies and hapten specificity.

Dolovich J, Bell B.

Abstract

Patient D.H., on chronic hemodialysis, developed severe allergic reactions after exposure to articles such as plastic tubing and hemodialysis supplies which had undergone cold sterilization with ethylene oxide (EO) gas. It was shown that human serum albumin (HSA) exposed to EO (EO-HSA) in the usual sterilization procedure selectively elicited positive skin tests and in vitro histamine release. It is now demonstrated that D.H. serum reacts selectively in a radioallergosorbent test (RAST) which utilizes discs coated with HSA and exposed to EO gas. In addition, D.H. serum contained IgG antibodies reactive with EO-HSA. This antibody activity was not detected in the sera of 27 normal subjects and 25 chronic hemodialysis patients. EO-HSA and ragweed RAST inhibition tests with a number of proteins in native form and after exposure to EO demonstrated the EO hapten specificity of the IgE antibody

[tricore]

Did we find out if we can get blood collected in glass bottles? Are they still manufactured? I haven't seen drawn blood that way since 1968! It is an open system since the needle does not come attached to the bottle.

[Mabel Adams]

On ‎10‎/‎5‎/‎2017 at 1:50 PM, Marilyn Plett said:

I'm curious about the "diagnosis". Was the allergist thinking out loud about possibilities? Or has he done some diagnostic testing and issued a report? Could a hyper-reactive immune system respond to some of the effects of storage on RBCs or WBCs? (I'm really going out on a limb here since by knowledge is limited). I've collected donor blood in glass bottles 40+ years ago and more recently for my brother-in-law the veterinarian who needed to transfuse a dog. I don't know if they're still available.

 

The report from the allergist included information from a conversation with a transfusion medicine physician at the local medical school who apparently mentioned the possibility of plasticizers being responsible.  I suspect that she overreacts to cytokines or something.  She got through the procedure without needing any blood.

[John C. Staley]

Amazing how conservative they can be with transfusions when motivated.  

[ADeCesare]

BYOB, I suggest.